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15030080CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030080 21040 HOMESTEAD RD CUPERTINO CA 95014 (326 07 034) OUTSTANDING CONSTRUCTION 18863 MEEKLAND AVE HAYWARD, CA 94541 OWNER'S NAME: HOMESTEAD CUPERTINO LP DATE ISSUED: 04/29/2015 OWNER'S PHONE: (408) 730-0808 PHONE NO: 510-861-9041 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #900681 Contractor OUTSTANDING CONSTRUCTION Date 04/30/2016 — BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — — — with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CODE ENFORCEMENT- SUITE 202 ADD PARTITION 18 L. FT I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's DEFERRED #1 - 2ND FLOOR BATHROOM GRAB BARS - ISSUED Compensation, as provided for by Section 3700 of the Labor Code, for the 10/27/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $3000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 07 034 326 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non-point source regulations pert C ertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/27/2016 Issued by: PAUL O'SULLIVAN OWNER-BUff.DFRDECLARATION Date: 04/29/2015 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF-ROOFS- All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 2 OS 533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 10/27/2016 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 10/27/2016 CUPERTINO ❑ NERI CONSTRUCTION CONSTRUCTION PERN�il i APPLICATION COM1 UNITY DEVELOPMENT DEPARTMENT • BUILDING DMP& V ISI®N # 1B 1030 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 77-3228 • FAX (408) 777-3333 - buildinola cuoertino.org ❑ ADDITION ❑ALTERATION / TI Del RE\%ISION /DEFERRED ORIGMAT_ P R14iT PROJECTADDRESS `Jj I�� - — ePv� 2_O� OWNER Kkhrr. i51 m PHONE 64--4SF-44 A�/1E-TLAIL ` STREET .ADDRESS 1 e^ '✓ �'Ok r I CITY, STATE, ZIP I' V I m l A q t r53M r a a CONTACT NAME N4" 5 r I PriO?`E r��i� �f�/�I E-h4iL STREET4DDRESS CITY, STATE, ZIP I FAX ON\`R ❑ OkRR-BUILDER ❑ w,;RAGtM T ❑ CONTRACTOR ❑ CONTRACTORAGET? ❑ ARCHITECT ❑ ENGWEER ❑ DEVELOPER ❑ T�pGT C0NM,kCTORNAh4 I LICENSENUMBER LICENSE TYPE BUS.LIC� COhipAi.'Y1:AME E-hfWL I FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ARCGTIECT/--K•GLN'�EER J:a?"E - jq \ �� LICENSE NUMBER / _ 2 z /(� t I BUS. LIC 1 COMPANY NAME �• •j� � � E-MAIL FAX STREET ADDRESS VIVA COcupRY, ST.A i E, TiP h / n q ' got I PHONE DESCRIPTION, OF WORK j7e v d i -b I n S+ I' At EXISTNIG USE PROPOSED USE CONSTR 117PE ; STORIES USE TYPE OCC. SQ.FT. VALUATION (i) EXISIG NEW FLOOR DEM10 TOTAL AREA AREA I AREA, >r -ET AREA BATMOM KITCHEN OTHER RIEMODELAREAREMODEL ARE.!. RE1,40DELAREA FOR A=.EA DECK AREA TOTAL D CKPORCH AREA GARAGE AREA: DETACH ❑ ATTACH I r DN'ELLL'eG UNITS: lS A SECOND L: IT ❑ 1iS SECOND STORY ❑ YES BELNG ADDED? ❑ No ADDITION? ❑ NO PRE-VPLICATION ❑ YES IF YES, PROVIDE PLA\?WGA?PL# ❑VO PLkNXINGAPPe2 tOPY OF VALLETTER ( 1S THE BLDG AN ❑YES EICHLERHOME? ❑NO ^RECEII'ED B1 ` . sem ,� ,1� �. TOTAL V?-LUAT10 .zn'' By my signature below, I certify to each of e following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have prov ' ed is corect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local 'on. ordinances and state la\vs relating to buil rsa I authorize representatives of Cupertino to enter the above -identified property/ for inspection pin -poses. Sigmture of Applicant/Agent: Date: Z 6 SUPPLEMENTAL I'\ n4ATION REQUIRED �.,�� •- PLS\:CHECh TIPE% New SFD or Multifalnil y dwelling : Apply for demolition pennit for �] O1 ER TER' -- existing building(s). Demolition penni is required prior to issuance ofbuilding -T= -COL' permit for new building. =_-�PIu 5 9LAN\[\GSL _Commercial Bldss: Protide a con, leted Hazardous Materials Disclosure D STA\'DMRD ILI PLI BLICVCPKS fora if any Hazardous Materials are bei .g esed as part of this project. ❑ L'.RGE ❑ FIRE DEPT Copy of Planning Approval Letter r Meeting with Planning prior to submittal of BuildinPenn g it i it zpplicatio . 4JC'R c.t\[T�.RI SE-'i1RDiSTR-TCT E\IR IRON7,IENTAL FEAL'I H B1dg1PP_2011.doc revised 06/21/11 K( CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21040 HOMESTE RD (�N fja TOR: L PERMIT NO: 15030080 OWNER'S NAME: HOMESTEAD CUPER INO LP DATE ISSUED: 04/29/2015 OWNER'S PHONE: 4084884965 PHONE NO: LICENSED CONTRACTUR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] (.� CODE ENFORCEMENT- SUITE 202 ADD PARTITION 18 L. # OO �4 License Class U���",�{�� FT 1L.i(c.. t� 6*4,d 70 r Contractor rT4-- l to Date V�� 1 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and ffect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $3000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this A PN' Number: 32607034.00 Occupancy T p y yPe� permit is issued. APPLICANT CERTI CATION I certify that I have read this application and stat, that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and count Orand state laws relating WITHIN 180 DAY SUANCE OR to building construction, and hereby authorize re resentatives of this city to enter upon the above mentioned property for inspectio purposes. (We) agree to save 180 D M ED INSPECTION. indemnify and keep harmless the City of Cuperti o against liabilities, judgments, costs, and expenses which may accrue against s d City in consequence of the Issued Date: VI?S granting of this permit. Additionally, the applic t understands and will comply with all non -point source regulations per the Cu rtino Municipal Code, Section 9.18. RE -ROOFS: \�ZC ( Signature Date l All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DE LA TION Signature of Applicant: Date: I hereby affirm that I am exempt from the Co ractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended r offered for sale (Sec. 7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Profe ions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one o the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent t self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of a Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is is ued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation surance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performanof the work for which this r/ x Owner or authorized agent: Date: permit is issued. 1 certify that in the performance of the work for wh ch this permit is issued, I shall not employ any person in any manner so as to beco a subject to the Worker's Compensation laws of California. If, after making is certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation pro Psion of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this perm' shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino ainst liabilities, judgments, costs, and expenses which may accrue against said Pty in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant derstands and will comply with all non -point source regulations per the Cupert' o Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION 1% 6* � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ''\\ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255a1U�V (408) 777-3228 • FAX (408) 777-3333 • building cugertino.org ` 11 . IXI — rr,. r nwi i= F1 Drtncin'm /T)T:TT=RRFT) ` r)P1r TNAT PT=RMTT ti PROJECT ADDRESS 2 O j U y }�� p� � �� I APN '4 �1'C5-`L� Q PHONE OV,rNERNAME L1„C E-MAILp �C �l l r �J l' f --(—L C � LQ STREET ADDRESS 6 O (�� CITY, STATE, ZIP , S 2 CA FAX ^ PHONE O CONTACT NAME \�+ �'J � � [ v pry E-14AIL�tI n ' I Y,STATE, ZIP STREET ADDRESS -7O 1II J W_ ek) C / o � k_ ��YOM V❑DOWNER r a yh / PAX /CTS(,❑ A`GEGENT`-C- ❑ CO2.'TRACTOR ❑ CONTRACTOR AGENT ARCCHITE' ENGINEER ❑ DEVELOPER ❑ TENANT ❑ OWNER ❑ O AINTR-BUILDER CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGIN'EER NAME LICENSE NUMBER 2 i I BUS. LIC # i� , 3 Z COMPANY NAMEA , J Lsvt ?f . _ I _tk„1, ' p EMAIL ry� I _,Ada Ye a Kh . U r FAX STREET ADDRESS ��� I ✓�hS l i C k 4_17 b CITY, STATE, ZIP PYl PHONE C (L S _ / may` DESCRIPTION OF WO ICA pt't I M t o (t P, P -ts 1 n o -w a r44;e 10 "G( Doy Y _ _ EXISTING USE PROPOSED USE CONSTR. TYPE k STORIES .& 2 USE TYPE OCC. SQ.FT. VALUATION (S) AREA AREA NEW FLOOR AREA DEMO AREA TOTAL TOT AREA 1 yD v 0-z �^ "$ / BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AT.S.�ASE_Clll) TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH 9 DWELLING UNITS: UNIT ❑ YES SECOND STORY ElYES ING ADDED! NO ADDITION' E] NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANMNGAPPL. NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLERHOME? NO DB � X""" x E s� dt TOTAL VALUATION: '21 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu' ding constructi . I au orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent: Date: l2 SUPPLEMENTAL INFORMATION REQUIRED -�� PLAI�CHECKT]PE "- �}} °� . �- a :�ROT7T:II�GSLIP,-.� tv'_ New SFD or Multifamily dwellings: Apply for demolition permit for ovER raE coTr.TER 17 fl Buu n�nePLAi` itE«Ewy existing building(s). Demolition permit is required prior to issuance of building permit for new building. Cik ExPREss £ t� + PI AN NTING PLf r. i2EVIETv , Commercial Bldgs: Provide a completed Hazardous Materials Disclosure {�� •Sk k S.e^YY TsrALDARD ,�.r �a`��� cif � '+`l F t > oBI icwDRxs� _ form if any Hazardous Materials are being used as part of this project. © 3 Copy of Planning Approval Letter or Meeting with Planning prior to LARGE t ELRE DEPT �s t _ submittal of Building Permit application.�� -❑ 1IAJOR ,s {' -� cD 'SANITARY FAV STRICT y B1dgApp_2011.doc revised 06/21/11 Y1 W -,��,���� CITY OF CUPERTINO M- JJI FFF F4TIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary sewer'Utstrtct, senoot n.�f.:,.. e., Th— foot nro hacod nn Jho nroliminary information availahle and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS Fee Resolution 11-05 E . 7/1113 ADDRESS: 21040 homestead rd DATE: REVIEWED BY: mendez dlcclr. Perwit Fee• APN: BP#: S 'VALUATION: 1$3,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARYPENTAMATION USE: Commercial Building Plumb. Insp. Fee: PERMIT TYPE: 1 GENCOM WORK To Clear Code Enforcement Case: suite 202 add parition 18 I.ft SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary sewer'Utstrtct, senoot n.�f.:,.. e., Th— foot nro hacod nn Jho nroliminary information availahle and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS Fee Resolution 11-05 E . 7/1113 ;ifech. Plan Check I Phuuh. Plan Check Elec. Plan Che, dlcclr. Perwit Fee• Plumb. Permit Fee: 17, le Permit Fee othcr llech. Insp, other Plumb Insp. 7.: c l >> Li Meeh. Inv). Fee: Plumb. Insp. Fee: 0.0 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, sanitary sewer'Utstrtct, senoot n.�f.:,.. e., Th— foot nro hacod nn Jho nroliminary information availahle and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS Fee Resolution 11-05 E . 7/1113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =If. $503.00 Interior Partitions 1PARTICOMM Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feels Reg. Q OT ,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? p Y s 0 No $503.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure E) O i Travel Docruncrtlutinn 1"ee.s: Strong Motion Fee: / sEISMICO $0.84 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $504.84 $503.00 TOTAL FEE: $1,007.84 Revised: 02/14/2015 UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CVPERTINO (408) 777-3228 •FAX (408) 777-3333 • buildingacupertino.org (Fnr Tenant Imnmvements where the Cost of Construction does not exceed $139,934.00) /5-030D"79 SITE ADDRES ADDRESS S'nOA TC APN J BP# tSa3 CITY Y` 00 ZIP TOTAL CONSTRUCTION COST A $ ....... ....09 .......................... DESCRIPTION OF WORK: Z 0 ?S t -t: (8 ;tit PA2ttr►�.� t��- �O"��+T /Sa30p SO, The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards.(AII costs to he documented by antiml hids or other information accented by the Building Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature Description of access features to be provided: current standards? features to full comply? fully accessible? 1. Path of travel to accessible entrance. ool TOTAL COST OF$ PROPOSED UPGRADE $ 2. Cost of providing a primary entrance. (Including but not limited to, thresholds, landings, door hardware, ✓ •�� % $ max. door pull, etc. 3. Cost of providing the primary path of travel to the specific area of alteration, structural repair, or txrz $ addition. ?+ 4. Cost of providing accessible restroom facilities.. i $ 60"000 5. Cost of providing an accessible drinking fountain. (If $ required or if a drinking fountain is provided.) 6. Cost of providing accessible public telephones (if $ provided) 7. Cost of providing other accessible features, Including , / ZLF#QS- $ but not limited to, parking, storage, alarms etc. V FEATURES (B): $2. da D Has the same tenant performed work in the same tenants ace within the last three ears? Calculate (B / A) x 100% 7 % Description of access features to be provided: 111Strt rod L6(;f -tD ->vtlk" ►- s t� s - inst�I/ n�; rrc s . ool TOTAL COST OF$ PROPOSED UPGRADE PERCENTAGE (20% minimum expenditure is re wired •�� % ARCHITECT OR ENGINEER OF `RR/�CORD INFORMATION: I certify that the above noted information is true and correct. (( Name (print): .JaIL.-Uc. /��� Signature: ��� Date: Firmaddress: ���� 5+e��►�s �►`�`'r�/VE`Z/ Title:7�LfT�>t Phone: TG 0"S—// - FOR DEPARTMENT USE ONLY --------------------------------------------------- / ❑ Tabove named project has been denied an unreasonable hardship exemption under 2010 CBC Section 1134B.2.1. The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24 (Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B.2.1. COMMENTS: Cga4JR—m 14 64 --sal 01-1 CA>io aon! / t 43 SEI rJirJ t-..1'�v,,-�7 � - C�vRG�,t'1��• cos -r- as /NsT�4t.w�G A �ix.J Building Official Designee (print):�d�� t—�"L Signature: //] Date: S NardshipExemptionForm_2012.doc revised 10/17/13